Tag Archives: learning environment

Scientific Literacy: A Challenge, a Task, a Poem

Scientific literacy allows citizens to get involved in issues and ideas related to science as a reflective citizen[1]. A scientifically literate person can:

  1. Recognize, offer and evaluate explanations for a variety of scientific and technological phenomena
  2. Describe and evaluate scientific research and propose ways to answer questions and solve problems following the scientific method
  3. Analyze and evaluate data, concepts and arguments in a variety of contexts, reaching appropriate conclusions for the data received[1]

 

The challenge

Quality education is the key to achieving literate societies. Unfortunately, scientific literacy is generally very low in most developing countries. Results of the PISA tests, for example, reveal that competencies in mathematics and sciences in developing countries are below the average of the countries evaluated[2]. This has enormous consequences for the communities by negatively impacting their political, economic and social decision-making.

 

Figure 1. Performance in mathematics and science of different countries in the 2015 Pisa tests. Images Taken from http://www.oecd.org/pisa/.[2]

The task

It is very important to open spaces for the general community in developing countries to learn about the practice of science. Many scientific organizations develop training activities that are usually directed at specialized audiences. For this reason, it is important to highlight the task of scientific associations that are concerned with bringing science to the general community such as the American Physiological Society through events such as PhUn week. In the particular case of Colombia, the Colombian Association for the Advancement of Science (ACAC) organizes every two years a very large science fair “Expociencia” that is visited by more than 40,000 elementary, middle and high school students.

 

These science fairs have several objectives:

  1. Allow students to present the results of scientific projects. Students are exposed to an essential component of science, sharing and communicating research. In addition, they have the opportunity to learn from their peers and receive feedback from more experienced researchers.
  2. Open the doors of academic, governmental or industry laboratories to the community. Visitors have the opportunity to know what scientists do, interact with them, expose their visions about science. In addition, visitors can express doubts they have about different concepts, and sometimes they can find answers to their questions.
  3. Generate academic spaces so that researchers can discuss how to work with the community, address their most pressing needs and communicate their results to the public.

Figure 2. Participation of students in academic activities at Expociencia 2018. Images courtesy of Deiryn Reyes, ACAC.

Recently with the support of the Faculty of Medicine of the Universidad de los Andes, I had the opportunity to participate in Expociencia[3]. It was gratifying to see how the children ran from one side to the other having the opportunity to learn about electronics, physics, programming, biology, medicine and anthropology. These children are like sponges that quickly absorb the information they receive and are willing to ask questions without filtering them through mechanisms that adults have learned. In addition, Expociencia promotes spaces for university students to share their experiences and for a moment to be role models for school students. I believe that many lives are changed thanks to the experience of living science.

 

The poem

In the nineteenth century lived a poet who wrote and translated from other languages several of the best-known stories that are known by children and adults in Colombia. His influence on Colombian literature is similar to that of the Grimm brothers in Europe. The name of this writer was Rafael Pombo. A few weeks ago, thanks to my son, I had the opportunity to learn that he also wrote about the importance of knowledge and science. On this occasion I want to share a personal translation of one of Rafael Pombo´s poems, that can be used to discuss with small children and adults the importance of science in our lives.

 

THE CHILD AND THE OX

Rafael Pombo (1833-1912)

The boy

 

-What do you think about all day

Lying on the grass?

You seem to me a great doctor

Enraptured in his science.

 

The ox

-The science, dear child

It is not what feeds me;

That is the fruit of study,

With what God gives humans.

 

Out thinking for me,

Poor animal, hard enterprise;

I prefer to make thirty furrows

Before learning two letters.

 

Chewing well, I care more

that a lesson at school.

With the teeth, I chew,

You, child, with your head.

 

But if you want to be wise

Hopefully seeing me you´ll learn

To ruminate, and ruminate a lot,

Every bit of science.

 

Digesting, not eating,

It is what the body takes advantage of,

And the soul, invisible body,

has to follow such a rule.

 

Without ruminating it well, do not swallow

Not a line, not a letter;

The one who learns like a parrot,

Ignorant parrot stays.

 

References

  1. National Academies of Sciences, E., and Medicine., Science Literacy: Concepts, Contexts, and Consequence. 2016.
  2. OECD. Results by Country. [cited 2018 November 4th]; Available from: http://www.oecd.org/pisa/.
  3. Ciencia, A.C.p.e.A.d.l. Expociencia 2018. 2018 [cited 2018 October 31st]; Available from: https://expociencia.co/home/.
Ricardo A. Peña-Silva M.D., PhD is an associate professor at the Universidad de los Andes, School of Medicine in Bogota, Colombia, where he is the coordinator of the physiology and pharmacology courses for second-year medical students. He received his doctorate in Pharmacology from The University of Iowa in Iowa City. His research interests are in aging, hypertension, cerebrovascular disease and medical education. He works in incorporation and evaluation of educational technology in biomedical education.

He enjoys spending time with his kids. Outside the office he likes running and riding his bicycle in the Colombian mountains.

 

 

 

Questioning How I Question

For some, “assessment” is sometimes a dirty word, with visions of rubrics, accreditation reports, and piles of data.  Readers of this blog hopefully do not have this vantage point, thanks in part to some great previous posts on this topic and an overall understanding of how assessment is a critical component of best practices in teaching and learning.  Yet, even as a new(ish) faculty member who values assessment, I still struggle with trying to best determine whether my students are learning and to employ effective and efficient (who has time to spare?!) assessment strategies.  Thus, when a professional development opportunity on campus was offered to do a book read of “Fast and Effective Assessment: How to Reduce Your Workload and Improve Student Learning” by Glen Pearsall I quickly said “Yes! Send me my copy!”

 

Prior to the first meeting of my reading group, I dutifully did my homework of reading the first chapter (much like our students often do, the night before…).  Somewhat to my surprise, the book doesn’t start by discussing creating formal assessments or how to effectively grade and provide feedback.  Rather, as Pearsall points out “a lot of the work associated with correction is actually generated long before students put pen to paper. The way you set up and run a learning activity can have a profound effect on how much correction you have to do at the end of it.” The foundation of assessment, according to Pearsall is then questioning technique. 

 

Using questions to promote learning is not a new concept and most, even non-educators, are somewhat familiar with the Socratic Method.  While the simplified version of the Socratic Method is thought of as using pointed questions to elicit greater understanding, more formally, this technique encourages the student to acknowledge their own fallacies and then realize true knowledge through logical deduction[1],[2].  Compared to the conversations of Socrates and Plato 2+ millennia ago, modern classrooms not only include this dialectic discourse but also other instructional methods such as didactic, inquiry, and discovery-based learning (or some version of these strategies that bears a synonymous name).  My classroom is no different — I ask questions all class long, to begin a session (which students answer in writing to prime them into thinking about the material they experienced in preparation for class), to work through material I am presenting (in order to encourage engagement), and in self-directed class activities (both on worksheets and as I roam the room).  However, it was not until reading Pearsall’s first chapter that I stopped to question my questions and reflect on how they contribute to my overall assessment strategy.

 

Considering my questioning technique in the context of assessment was a bit of a reversal in thinking.  Rather than asking my questions to facilitate learning (wouldn’t Socrates be proud!), I could consider my questions providing important feedback on whether students were learning (AKA…Assessment!).  Accordingly, the most effective and efficient questions would be ones that gather more feedback in less time.  Despite more focus on the K-12 classroom, I think many of Pearsall’s suggestions[3] apply to my undergraduate physiology classes too.  A brief summary of some strategies for improving questioning technique, separated by different fundamental questions:

 

 

How do I get more students to participate?

  • We can “warm up” cold calling to encourage participation through activities like think-pair-share, question relays, scaffolding answers, and framing speculation.
  • It is important to give students sufficient thinking time through fostering longer wait and pause times. Pre-cueing and using placeholder or reflective statements can help with this.

How do I elicit evidentiary reasoning from students?

  • “What makes you say that?” and “Why is _____ correct?” encourages students to articulate their reasoning.
  • Checking with others and providing “second drafts” to responses emphasizes the importance of justifying a response.

How do I sequence questions?

  • The right question doesn’t necessarily lead to better learning if it’s asked at the wrong time.
  • Questions should be scaffolded so depth and complexity develops (i.e. detail, category, elaboration, evidence).

How do I best respond to student responses?

  • Pivoting, re-voicing, and cueing students can help unpack incorrect and incomplete answers as well as build and explore correct ones.

How do I deal with addressing interruptions?

  • Celebrating good practices, establishing rules for discussion, making it safe to answer and addressing domineering students can facilitate productive questioning sessions.

 

After reviewing these strategies, I’ve realized a few things.  First, I was already utilizing some of these techniques, perhaps unconsciously, or as a testament to the many effective educators I’ve learned from over the years.  Second, I fall victim to some questioning pitfalls such as not providing enough cueing information and leaving students to try their hand at mind-reading what I’m trying to ask more than I would like.  Third, the benefits of better questioning are real.  Although only anecdotal and over a small sampling period, I have observed that by reframing certain questions, I am better able to determine if students have learned and identify what they may be missing.  As I work to clean up my assessment strategies, I will continue to question my questions, and encourage it in my colleagues as well.

 

1Stoddard, H.A. and O’Dell, D.A. Would Socrates Have Actually Used the Socratic Method for Clinical Teaching? J Gen Intern Med 31(9):1092–6. 2016.

2Oyler, D.R. and Romanelli, F. The Fact of Ignorance Revisiting the Socratic Method as a Tool for Teaching Critical Thinking. Am J of Pharm Ed; 78 (7) Article 144. 2014.

3A free preview of the first chapter of Pearsall’s book is available here.

Anne Crecelius (@DaytonDrC) is an Assistant Professor in the Department of Health and Sport Science at the University of Dayton where she won the Faculty Award in Teaching in 2018.  She teaches Human Physiology, Introduction to Health Professions, and Research in Sport and Health Science. She returned to her undergraduate alma mater to join the faculty after completing her M.S. and Ph.D. studying Cardiovascular Physiology at Colorado State University.  Her research interest is in the integrative control of muscle blood flow.  She is a member of the American Physiological Society (APS), serving on the Teaching Section Steering Committee and will chair the Communications Committee beginning in 2019.  In 2018, she was awarded the ADInstruments Macknight Early Career Innovative Educator Award.
Teaching for Learning: The Evolution of a Teaching Assistant

An average medical student, like myself, would agree that our first year in medical school is fundamentally different from our last, but not in the ways most of us would expect. Most of us find out that medical school not only teaches us about medicine but it also indirectly teaches us how to learn. But what did it take? What is different now that we didn’t do back in the first year? If it comes to choosing one step of the road, being a teaching assistant could be a turning point for the perception of medical education in the long run, as it offers a glimpse into teaching for someone who is still a student.

At first, tutoring a group of students might seem like a simple task if it is only understood as a role for giving advice about how to get good grades or how to not fail. However, having the opportunity to grade students’ activities and even listen to their questions provides a second chance at trying to solve one’s own obstacles as a medical student. A very interesting element is that most students refuse to utilize innovative ways of teaching or any method that doesn’t involve the passive transmission of content from speaker to audience. There could be many reasons, including insecurity, for this feeling of superficial review of content or laziness, as it happened for me.

There are, in fact, many educational models that attempt to objectively describe the effects of educating and being educated as active processes. Kirkpatrick’s model is a four-stage approach which proposes the evaluation of specific aspects in the general learning outcome instead of the process as a whole (1). It was initially developed for business training and each level addresses elements of the educational outcome, as follows:

  • Level 1- Reaction: How did learners feel about the learning experience? Did they enjoy it?
  • Level 2- Learning: Did learners improve their knowledge and skills?
  • Level 3- Behavior: Are learners doing anything different as a result of training?
  • Level 4- Results: What was the result of training on the business as a whole?

Later, subtypes for level 2 and 4 were added for inter-professional use, allowing its application in broader contexts like medicine, and different versions of it have been endorsed by the Best Evidence in Medical Education Group and the Royal College of Physicians and Surgeons of Canada (1) (2).  A modified model for medical students who have become teachers has also been adapted (3), grading outcomes in phases that very closely reflect the experience of being a teaching assistant. The main difference is the inclusion of attitude changes towards the learning process and the effect on patients as a final outcome for medical education. The need for integration, association and good problem-solving skills are more likely to correspond to levels 3 and 4 of Kirkpatrick’s model because they overcome traditional study methods and call for better ways of approaching and organizing knowledge.

Diagram 1- Modified Kirkpatrick’s model for grading educational outcomes of medical student teachers, adapted from (3)

These modifications at multiple levels allow for personal learning to become a tool for supporting another student’s process. By working as a teaching assistant, I have learned to use other ways of studying and understanding complex topics, as well as strategies to deal with a great amount of information. These methods include active and regular training in memorization, deep analysis of performance in exams and schematization for subjects like Pharmacology, for which I have received some training, too.

I am now aware of the complexity of education based on the little but valuable experience I have acquired until now as a teacher in progress. I have had the privilege to help teach other students based on my own experiences. Therefore, the role of a teaching assistant should be understood as a feedback process for both students and student-teachers with a high impact on educational outcomes, providing a new approach for training with student-teaching as a mainstay in medical curricula.

References

  1. Roland D. Proposal of a linear rather than hierarchical evaluation of educational initiatives: the 7Is framework. Journal of Educational Evaluation for Health Professions. 2015;12:35.
  2. Steinert Y, Mann K, Anderson B, Barnett B, Centeno A, Naismith L et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40. Medical Teacher. 2016;38(8):769-786.
  3. Hill A, Yu, Wilson, Hawken, Singh, Lemanu. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school. Advances in Medical Education and Practice. 2011;:157.

The idea for this blog was suggested by Ricardo A. Pena Silva M.D., Ph.D. who provided guidance to Maria Alejandra on the writing of this entry.

María Alejandra is a last year medical student at the Universidad de Los Andes, School of Medicine in Bogota, Colombia, where she is has been a teaching assistant for the physiology and pharmacology courses for second-year medical students. Her academic interests are in medical education, particularly in biomedical sciences.  She is interested in pursuing a medical residency in Anesthesiology. Outside medical school, she likes running and enjoys literature as well as writing on multiple topics of personal interest.
Why do you teach the way that you do?

Have you ever stopped to think about why you do something the way that you do it? We educators are often very good at describing what we do or have done. I was recently reviewing some CVs for a teaching position; all the CVs were replete with descriptions of what content was taught in which course at which institution. However, I feel that we educators often fail to capture why we teach in a certain way.

 

 

In my extra-curricular life, I am an educator on the soccer field in the form of a coach. Through coaching education, I have been encouraged to develop a philosophy of coaching. This is a description of why I coach the way I do. To develop a coaching philosophy, coaches should think about three central aspects (see: https://www.coach.ca/develop-a-coaching-philosophy-in-3-easy-steps-p159158 for more details):

 

  1. Purpose: why do you coach?

  2. Leadership style – what methods do you use to coach? Are you more ‘coach-centered’ or more ‘player-centered’ in your approach? Or somewhere in between? Why?

  3. Values: what is most important to you? How does it affect the way you coach?

 

If ‘coach’ is replaced by ‘teach’ or ‘teacher’ in the above list, and ‘player’ is replaced by ‘student’, we can use this framework to develop a philosophy of teaching. I have found that putting ‘pen to paper’ in forming a philosophy helps to crystallize your beliefs about teaching that may have been seemingly random, disparate thoughts previously. It can be insightful to synthesize your beliefs about teaching, as it provides some structure and guidance when planning future teaching.

 

It is time to nail my colors to the mast. I teach because I want to help my students be successful diagnosticians in their profession (medicine) and understand why their patient’s bodies are responding in the way that they do in order to help them treat them effectively. I do believe in the benefit of having an expert instructor, especially when you have novice students, so I am probably more teacher-centric than is the current fad. However, I don’t like lectures for the most part, because from my perspective, lectures principally focus on information transfer rather than using and applying the important information. This is not to say that lectures are all bad, but I prefer ‘flipped classroom’ methods that require students to gather the necessary knowledge before class, and then during class, demonstrate mastery of material and apply it to clinical scenarios (with the aid of the instructor). But, that’s me. What about you?

 

If you are applying for positions that will require teaching, having both a teaching philosophy and a teaching portfolio will provide the appropriate evidence to the search committee about how you plan to teach.  The following resources might be useful to you:

Preparing a Teaching Portfolio http://www.unco.edu/graduate-school/pdf/campus-resources/Teaching-Portfolio-Karron-Lewis.pdf

Writing Your Teaching Philosophy https://cei.umn.edu/writing-your-teaching-philosophy

  Hugh Clements-Jewery, PhD is currently Visiting Research Associate Professor at the University of Illinois College of Medicine in Rockford, Illinois. He teaches medical physiology in the integrated Phase 1 undergraduate medical curriculum at the University of Illinois College of Medicine. He is the College-wide leader for the Circulation-Respiration course. He has also recently taken on the role of Director of Phase 1 curriculum at the Rockford campus.
BOOK REVIEW: Teach Students How to Learn: Strategies you can incorporate into any course to improve student metacognition, study skills, and motivation

I recently had a conversation with my son who teaches high school math and computer science at a Catholic college-prep girls high school in San Jose, CA about how his students did not realize that they were learning from his innovative standards-based teaching approach.  We had already discussed how mindset has a big impact on student learning at an early age; how K-12 students are not taught appropriate study skills for future educational experiences; and how students do not understand how they learn.  Thus, I went out looking for resources to help him deal with these learning issues.  By searching on Amazon, I found the book Teach Students How to Learn:  Strategies You Can Incorporate Into Any Course to Improve Student Metacognition, Study Skills, and Motivation by Saundra Yancy McGuire with Stephanie McGuire (ISBN 978-1-62036-316-4) which seemed to be just what we wanted.  Dr. McGuire taught chemistry and has worked for over 40 years in the area of support for teaching and learning.  She is an emerita professor of chemical education and director emerita of the Louisiana State University Center for Academic Success.  Her daughter Stephanie is a Ph.D. neuroscientist and performing mezzosoprano opera singer who lives in Berlin, Germany.

The book has interesting and self-explanatory chapters about Dr. Saundra McGuire’s own evolution as a teacher (and as a chemistry major I could really relate to her story), discussions about why students don’t already know how to learn when they come to college, what metacognition can do for students to help them become independent learners, how to introduce Bloom’s taxonomy and “the study cycle” to students, how to address student growth vs. fixed mindset status, and how both faculty and students can boost motivation, positive emotions, and learning.  The study cycle learning strategy proposed and used by Dr. McGuire over the years involves five steps for the students: preview before class, attend class and take meaningful notes, review after class, study by asking “why, how, and what if” questions in planned intense study sessions and weekend reviews, and assess their learning by quizzing or planning to teach it to others.  Especially helpful for teachers are the actual presentations as three online slide sets and a sample video lecture (styluspub.presswarehouse.com/Titles/TeachStudentsHowtoLearn.aspx), and a handout summarizing the entire process that Dr. McGuire uses to introduce her learning strategies to groups of students in as little as one 50-minute class period.  Throughout the book, there are summary tables, examples, activities, and success stories about students who have incorporated the learning strategies.

In Appendix D of the book (pp. 176-177), Dr. McGuire includes a handout entitled “Introducing Metacognition and Learning Strategies to Students: A Step-by-Step Guide” for the 50 minute session.

An abbreviated version of the 15 steps are repeated here:

  1. Wait until the students have gotten the scores of their first test back.
  2. Don’t tell the class in advance that there will be a presentation on learning strategies.
  3. Evaluate student career goals by clickers or show of hands at beginning of session.
  4. Show before and after results from other students.
  5. Define metacognition.
  6. Use exercise to show the power of various learning strategies.
  7. Ask reflection questions, like “What is the difference between studying and learning?
  8. Introduce Bloom’s taxonomy.
  9. Introduce the study cycle as way of ascending Bloom’s.
  10. Discuss specific learning strategies like improving reading comprehension (active reading) and doing homework as formative assessment.
  11. Discuss reasons students in the class may or may not have done well on the first test.
  12. Ask students how different the proposed learning strategies are to the ones that they have been using.
  13. Ask students to commit to using at least one learning strategy for the next few weeks.
  14. Direct students to resources at your campus learning center.
  15. Express confidence that if students use the learning strategies they will be successful.

Currently all of the students that I teach are either advanced undergraduate students planning to go to professional schools or graduate students, so that my current students do not have mindset or motivational issues and have mostly learned how they study best.  However after sharing this book review with you, I have convinced myself that I cannot give up my book to my son when he comes to visit next month and I will need to go and buy another one.  I hope that this book will help you facilitate the learning of your students too!

Barb Goodman received her PhD in Physiology from the University of Minnesota and is currently a Professor in the Basic Biomedical Sciences Department of the Sanford School of Medicine at the University of South Dakota. Her research focuses on improving student learning through innovative and active pedagogy.
Surviving Hurricane Maria: A professor’s story (Part 2)

Previously in our story…Hurricane Maria had just ravaged the island nation of Dominica

Flag of Saint Kitts and Nevis

While I waited, my school did what many said could not be done. Our staff and administration arranged for us to be able to complete the fall semester, on the only-lightly damaged island of St. Christopher (usually called St. Kitts), which had been grazed by both Irma and Maria.  They arranged for a large passenger ship which normally ferried cars and people from Italy to Spain and back to sail over to the Caribbean and be modified into a floating campus for our thousand-plus student body for the rest of the year.  They arranged for temporary accommodations for faculty and staff on St. Kitts, where our other sister school, Ross University School of Veterinary Medicine (10), is located.  They revised the schedule to have us resume our semester in October and finish in early January.  And then they set these plans in motion.

In mid-October, I finally got the notice I’d been waiting for, my reporting day to arrive on St. Kitts for my temporary assignment there.  I’d lived on St. Kitts before while working at one of my former schools, so I knew that it wasn’t the same as Dominica.  It was wealthier, far wealthier, with so many cruise ships coming to call during high season that we were almost an afterthought to them.  It had the movie theater and the golf courses and the high-end hotels, and the island infrastructure to handle the mass of tourists who came and went by the planeload and shipload every day.  But on the same token, in Dominica we were a part of the community, we were welcomed by the people, and we were careful to try to be good neighbors.  In St. Kitts, we were mostly treated like tourists, who were perhaps staying a little longer than usual, and on a ship that wasn’t going to sail away with us.  Most of the Kittitians were still the very friendly people you can find everywhere in the Caribbean, of course, but it wasn’t Dominica and I knew it before I arrived.  We faculty were to arrive a few days before the students to get situated and find places to live on the island while the student accommodations/our campus continued its journey across the Atlantic to our new home away from home.

Belle Mont Farm Eco-Resort

When I got to St. Kitts, it was…a pleasant surprise.  It wasn’t half as hard to get through customs as I had feared, and the Marriott is a nice hotel.  We stayed there a day or two before the students started to arrive.  To make room for the students, most of the faculty were moved to an eco-resort on the far side of St. Kitts for about a week, which opened in its off-season just for us.  While I appreciated their going above and beyond on our behalf, I only stayed one night before moving into an apartment in town. I just wanted to unpack my suitcases, settle in somewhere, and get back into a routine.

Because I left the eco-resort so early, I was available to help the students come in on their arrival day.  And come in they did, one charter flight at a time to the airport, and one to three buses (they call them cruisers) at a time to the Marriott.  Tired, bleary-eyed, some clearly still suffering the effects of six or more days on Dominica under indescribable conditions ending in evacuation and weeks of uncertainty, the students came.  You couldn’t help but feel for the ordeal they had survived… or admiration for their grit to return anyway, when a small group of others had taken a leave of absence.  On that day and night when the students came in charter flight after charter flight, wave after wave, a dozen volunteers and I helped each group one by one.  We were the friendly faces from home greeting them after their long ordeal.  We smiled and shook their hands and took their bags inside, helped them through check-in, provided them some simple meals, and tried to make each returning student feel special.  It started for me in the afternoon, and then into the evening, and then into the night, with each group of students arriving more and more exhausted.  By 1 a.m. I was feeling pretty exhausted too, but we kept going until the very last group made it in somewhere close to 2 a.m.

I am told that still more planeloads of students flew in the next morning, but I slept in.  That afternoon, students were being transported from the hotel to the port, where our ship had come in.  The lines were long and the sun was hot and the students just wanted to get inside and get to their new berths.  Many of the faculty who were staying at the eco-resort had come into town that morning to help students move in during the morning/afternoon shift.  I showed up for the afternoon/evening shift.  As we had done the previous day, we volunteers did our very best to keep everyone comfortable at the port, as students went through the tedious process of being identified, cleared to come onto the ship, given berth assignments, and other things past my station at the port.  I made a point to smile and joke and most students appreciated it.  By mid-evening the last students had made it past my sorting station at the dock entrance and headed into the ship, so I stumbled home for another exhausted sleep.

There was a lot more involved in starting work at the temporary campus than just showing up, but I and the other faculty made do.  The ship had just one large cafeteria so we sometimes had to wait in meal lines during its designated breakfast-lunch-dinner times.  Many of the prior amenities on the ship (e.g., a movie theater and a pool deck) had been converted into classroom and study areas before we boarded, and other spaces were modified for student use later.  This included the conversion of an entire deck of the ship which is usually a car garage into an air-conditioned suite of temporary study spaces, clinical exam rooms, and simulation labs. Since the ship spent most days at sea, it was rather crowded at first.  We faculty didn’t have offices per se but like the students we each found our place to be during the day.  My place was at the back of the third semester classroom, in a corner with AC, electric hookups, and a view of the harbor.  I usually teach in second semester as do most physiologists, so I absorbed a lot of clinical applications even as I worked on lectures and active learning sessions, module directing, pre-mini-workshop design, and all the other routines of a typical teaching-oriented school.  And in so doing I, like so many other faculty who don’t get to know a lot of students normally, did connect with many of them.  When we had to get up at 3:30 a.m. to catch the 4:15 a.m. bus to get us to the boat before it sailed at 5:00 a.m. to make room for a set of larger cruise ships throughout the day, we shared in the students’ experience of having to make sure they too were up at the same time, early enough to download their most important materials of the day before we sailed, just in case the harbormaster put us far out at sea.  When the days came that other ships left late and we didn’t dock until 7:30 at night, the students shared that with us too.

Photo: St. Kitts in the morning light, mid-November 2017. Photo credit: Bruce Wright

Along the way, we made time for some activities.  Twice I went scuba diving with fellow members of our RUSM (Med School) Scuba Club (11); others went diving even more regularly.  People organized groups for exercise on the outside deck every morning and night.  There were religious services, club meetings, and other miscellaneous activities on the boat.  Off the boat there was at least one school-planned movie outing, an island tour, and a few students even made it to a “beach bash” hosted by the RUSVM (Vet School) Scuba Club.  More informally, the port facilities were nice as one would expect at a regular Caribbean cruise ship stop, with everything that entails. It became a shared experience of life in close quarters, dedicated to a common purpose and with a common spirit that we would make it through, together and with no drop in our commitment to teaching and learning despite it all.

Would I have traded it for a nice quiet semester in Dominica with no Hurricane Maria in the first place?  Well, sure!  But you have to deal with what life gives you and we made the best of it.  And the quality of the teaching did not go down.  We might have been in close quarters but we delivered virtually the same curriculum in the fall as we had in the previous spring and summer.

By mid-November, air service to Dominica was spotty but running, so I booked a trip there for a few days including Thanksgiving Day.  We’d just found out that we were going to be in Knoxville, Tennessee for the January semester but no one knew much more than that.  While some people started actively looking for places to live, I planned my return to Dominica and hoped the school would handle the Knoxville move for me and many others (it did).  I booked a room at the only hotel open in Portsmouth, Dominica, just in case my cottage was uninhabitable, and then I hoped for the best.

Photo: Sunset in Dominica, late November 2017. Photo credit: Bruce Wright

When I flew in, it was afternoon and, well, the island I loved looked different.  This was now two months after Hurricane Maria did its damage and still the island was brown, not green.  The volcanic ridges were sharp and distinct, and the remains of trees were all over them, standing tall and naked.  But if I looked closely, I could see that at the tops of the trees, leaves had started growing again.  Not enough to cover the scars on the land, not yet, but enough for some hope.  I had the taxi driver take me to my cottage before going to the hotel, and amazingly almost everything had survived.  The food and other perishables were gone with a few other items (e.g., my Swiss army knife), but overall I had a lot of things to ship home.  When someone had built the place he or she had cemented the window frames into the concrete wall for extra strength, which isn’t standard practice anywhere but it worked there.  Whoever it was had also put odd-looking vents under the roof which somehow prevented the roofs from flying.  As a result, though my furniture was flooded at floor level, almost everything else was salvageable.  It was a miracle compared to the sheer devastation we’d driven through from the airport to town.  That night I saw my first sunset on Dominica in many months, and it was beautiful.

Photo: Looking north from Portsmouth, Dominica, Thanksgiving Day 2017. Photo credit: Bruce Wright

I spent the next two days getting almost everything from my cottage packed up and sent to the local shipping agent for transport back to the USA.  Since my office had survived intact (another unexpected blessing) I took a couple of textbooks and other important items from there. But I didn’t take everything. I left most things in my office against the day I would return.  I also took a few photographs. I chose to avoid taking pictures of the damaged areas. Instead I shot photos of things I’d never seen before, like the caved-in side of a cliff face on the mountain north of town that to me looked just like a monkey’s hand.  Along the way I saw the determination of the people to recover even as they all hoped we would be back in May, and I hoped the same thing.  But it was not to be.  As I flew out with my bicycle sold, my cottage empty, and my most essential items from home and office in two suitcases, I was pretty sure that Dominica wouldn’t be ready for us by then.  There were still too many without power, too many living under tarps and in barely-repaired dwellings, too many roofs still off and the insurance companies being slow to pay claims.

The semester ended relatively uneventfully.  The students adjusted to where they were going to be in the spring, and so did I.  Knoxville, Tennessee is a nice southern city with both friendly people and all the movie theaters one could ever want. I even went once!  Most of our students are here with us, though some are still in St. Kitts with some of our faculty.  We’ve learned we’re to be here through the September 2018 semester so we have some sense of permanence.  Though I would love to return to Dominica as soon as possible, having a safe, happy Dominica with functional buildings, power, water, cell service, and the other non-movie theater basics restored is really important too, so I can’t complain.  Here I am, a professor at a medical school in the United States, just like I wanted to be so many years ago.  And whether here or Dominica or anywhere else my fate takes me, I’ll get by.

As I told one of my advisees who was having a bad day last December, in the end a school isn’t buildings at all.  A medical school is its people, medical faculty training students through increasingly difficult tasks until at the end the students have risen up to a higher level, doctors ready to begin their postgraduate medical education journey.  The medical arenas and the classrooms and the simulation labs and the journal collections and the fraternity/sorority homes and even the occasional Italian ship sailing thousands of miles to become a “floating campus” are all just the scaffolding around what is really important.  That one student, his or her classmates, his or her basic science and clinical faculty, and everyone else from the Dean to I.T. to the people washing dishes in the back of the cafeteria who make sure everything else runs…these people are the real school.  They make it possible for that one student to excel.

And that’s something that no hurricane– however powerful– can stop.  Ask LSU if it stopped for either Camille or Katrina.  Ask Hofstra if it stopped for Sandy, Baylor if it stopped for either Rita or Harvey, or Nova Southeastern if it stopped for either Andrew or Irma.  Like those other disasters, Hurricane Maria is part of history now. And just like those other schools went on after their respective storms, we’ll keep going too, training the next generation of physicians, semester after semester.  As we do, I’ll be right there doing my part for my students, my school, and the greater medical education community.  Because in the end, that’s not only what I was trained to do, it’s still my passion today.

Bruce E. Wright graduated with a PhD in Physiology from LSU Health Sciences Center in 1993.  He had postdoctoral fellowships/research faculty positions at the University of Florida and East Carolina University.  He served several years as faculty at a liberal arts college in Georgia.  He worked at three Caribbean medical schools from 2005-2008 before joining the faculty at Ross University School of Medicine in 2008.  He worked for two years at a US-based osteopathic medical school in 2013 and 2014 before returning to Ross University in late 2014.  Dr. Wright is currently Treasurer/Award & Event Coordinator for the American Physiological Society’s Teaching Section.  He has served as a reviewer for Advances in Physiology Education.  He is National Faculty for the National Board of Osteopathic Medical Educators (NBOME), for whom he has written and reviewed items for different exams.  He regularly attends Experimental Biology and was an attendee and presenter for the first Institute for Teaching and Learning meeting in Bar Harbor, Maine in 2014.  He is currently interested in educational research involving teaching methodologies.

Photograph: The author with three RUSM students (from left to right, Armin Hojjat, Harenda Ipalawatte, Bruce Wright, and Eddy Mora) just after a double-tank scuba dive, off St. Kitts, November 2017. Used with permission by Harenda Ipalawatte.

References/links/other:

  1. http://www.dominica.gov.dm/about-dominica/country-profile
  2. https://medical.rossu.edu/about.html
  3. http://www.dominica.gov.dm/tropical-storm-erika
  4. https://weather.com/storms/hurricane/news/tropical-storm-harvey-forecast-texas-louisiana-arkansas
  5. https://weather.com/storms/hurricane/news/hurricane-tropical-storm-irma-recap-2017
  6. https://en.wikipedia.org/wiki/Hurricane_Maria
  7. https://www.youtube.com/watch?v=l-5fHwER-Zc
  8. https://www.caricom.org/media-center/communications/press-releases/dominica-prime-minister-roosevelt-skerrit-addresses-the-un-general-assembly
  9. https://www.wunderground.com/cat6/category-5-hurricane-maria-hits-dominica
  10. https://veterinary.rossu.edu/about.html
Surviving Hurricane Maria: A professor’s story (Part 1)

It’s funny, as I begin to write this blog, that I realize that it’s nearly 25 years now since I received my Ph.D. in Physiology in New Orleans.  Back then, I was sure that my career track would lead me to becoming a full professor at a medical school in the United States one day, though I didn’t know exactly how I would get there.  Not being a world traveler, I certainly never expected to spend a day in the Caribbean, but life is funny sometimes.

Like so many other graduates of my day, the “optimal” career track didn’t pan out for me.  My postdoctoral experience didn’t involve receiving any federal grants, so instead of moving straight into medical school, I became involved in undergraduate education. Several years later while advising students, I learned about Caribbean medical schools. When I studied them in more depth, I discovered one program in particular in which I could teach college seniors advanced A&P part-time while I took medical school courses part-time too.  I took a leap of faith and applied for it. Shortly after they accepted me, I took my first flight over the turquoise-blue of the Caribbean Sea.

 

That was the day my life changed

There was and is something different about the Caribbean, its varied islands and its colorful people, so friendly in some places and so unfriendly in others, but always full of life and adorned in bright colors.  Along the way I picked up medical-level Gross Anatomy and with that extra qualification, moved into full-time faculty positions at a couple of small medical schools in the British and Dutch Caribbean.  On those tiny islands I relearned my discipline as a generalist as few others of my generation have done.  There I was THE physiologist with no backup and neither a travel allowance for attending conferences or taking trips home to see my family, nor support for any research.  Instead I had to not only teach the entire medical physiology course by myself three times per year, I also had to assist the anatomy faculty in cadaver dissection twice per week and occasionally teach in an undergraduate course.  My typical medical school course load was 14-16 hours per week of just contact time in lecture and lab, not counting writing exams every three weeks and having many, many meetings with students.  It was hard but it changed me, and made me a better teacher. With this Caribbean-acquired training as a medical physiology generalist, in 2008 I moved up to a first-tier Caribbean medical school in the Commonwealth of Dominica (not the Dominican Republic!), initially to teach digestive physiology.

 

Flag of the Commonwealth of Dominica

Dominica will always have a special place in my heart.  It is a small volcanic island in the British Caribbean that is shaped like a chrysalis (1).  At its widest it’s only about 18 miles and at its longest 29 miles, but it is almost a mile high. It has no five star resorts, no golf courses, and no movie theaters.  It’s hard to get to by air, and even cruise ships mostly go past it in favor of better-developed ports on the islands north and south of it. When I first arrived the entire population on-island was only about 73,000, mostly hugging the west (Caribbean) coast. But for several years I lived in a house on a hillside 500 feet above the Caribbean Sea watching the sun set over the ocean every night from my front porch. On Saturday I would sometimes go down to the village of Mero below me where there would be a half mile of pure gray sand beach and only a dozen people on it.  On Sunday, I might go down again to where five hundred locals had come to party on the beach, or I might have just sat on my porch and listened to the music from far below, as the stars came out and the Southern Cross hung in the April sky. One time, and only one time, I climbed the 4800 foot mountain in the center of the island where there is no trail up to the cloud-cloaked peak.  One time, I swam, dove, and rappelled down a river through a canyon greener than the Emerald City.  And along the way, I taught at a very special school, with smart, tough, high quality faculty and students alike, Ross University School of Medicine (2).

 

Photo: Dominica from my cottage porch, April 2017. Photo credit: Bruce Wright

Through most of my years there, Dominica was spared the worst that Mother Nature could bring to bear.  We liked to say that it was in the perfect place in the Lesser Antilles, too far north for the big Cape Verde hurricanes that would not be turned north as they tracked west through the Central Atlantic to hit, and too far south for those Atlantic storms that did get pulled north as they approached the islands.  Sometimes a tropical storm would come and dump a lot of rain but that just turned the tap water brown or white for a day, no big deal.  The island stayed its radiant green from the tropical rain forests, only browning out for 1-2 months per year in the dry season from January to April.

 

 

In 2015, Tropical Storm Erika formed almost on top of us, and hit the island with the worst rainfall it had experienced in decades.  Dozens of people died and whole towns were cut off for months.  We thought we’d been hit by the Big One, as the estimated damage from Erika’s island-wide flash flooding was about 500 million dollars, or well over half of Dominica’s gross domestic product (3). For two years the island slowly recovered, rebuilding its water treatment facilities, repairing washed-out bridges, and helping rebuild flooded coastal communities.

By August 2017, Dominica was almost completely back.  We too were back.  Our school had had its own water supply even before Erika hit, and the electricity never went out in Portsmouth afterwards. Like the rest of Dominica, my school did lose cell phone service and internet for several days after that storm, which was a serious concern.  Once we were reconnected with the world, we moved to make sure our school would never be caught like that again.  My school installed its own satellite, set up evacuation plans, and built a new student center rated to withstand a Category 5 hurricane. Along the way it continued to matriculate three sets of students per year, semester in and semester out.  Collectively, we thought we’d survived the worst and recovered very well.

No one expected the hurricane onslaught of 2017.  Three major hurricanes, three major disasters, with consequences felt in several parts of the United States, were always theoretically possible but most people didn’t expect more than one to pan out. In the middle of August, I was on vacation at my wife’s home in Georgia as eventual Major Hurricane Harvey formed in the Atlantic and passed south of Dominica as a tropical storm.  Most storms that go that way fizzle out in the eastern Caribbean, but Harvey survived and went on to ravage Houston and the surrounding region of the northwestern Gulf of Mexico like few hurricanes ever had (4). The United States’ people and its government mobilized to help Texas and Louisiana, as it so often does after a major disaster.  I breathed a sigh of relief that Dominica was spared again even as I too donated to help the Gulf coast.

I returned to work before the beginning of the September semester.  Irma was still far out to sea in the Central Atlantic, but it looked like it was going to be trouble almost as soon as it cleared Africa.  I told many first semester students days before Hurricane Irma reached the Lesser Antilles that they should invest in a full set of hurricane supplies as if it would be the worst storm they would ever experience in their lives. Then, when it didn’t hit, they could eat the food, drink the bottled water, and cook with the extra propane all semester long.  Some took this advice to heart and others didn’t.  As Hurricane Irma came closer and closer, it kept heading straight for Dominica, defying days of forecasts that it would turn northwest, and strengthening all the way to one of the strongest Category Five storms of all time.  Only at the last minute seemingly did it turn at last.

Irma was a terrible storm, even by historical standards (5).  It destroyed St. Maarten and several other islands but all we got from it was severe rain and tropical-storm force winds, with only minor damage to our fragile infrastructure.  We grieved for our comrades including our sister school American University of the Caribbean north of us, and then watched as this storm’s heaviest rain bands hit the Miami area, causing even more flooding damage only weeks after Houston’s deluge.  As our University headquarters were there, this had some effect on our operations, but again from Dominica we breathed a sigh of relief.  We had been spared the worst again.

Chugging along some distance behind Irma, another tropical wave came off of the African coast, looking suspicious right from the start.  Maria, as it was to eventually be named, was absolutely the worst case scenario for the island of Dominica and for our basic science campus there (6).  It wasn’t supposed to be a major hurricane when it hit.  The forecasts all said if it hit at all, it was likely to be a strong tropical storm, maybe a Category One.  Nevertheless, in preparing for a business trip to Chicago for the second week of September, I had a group meeting with my mentees a week early, because sometimes even a simple rainstorm over Puerto Rico could delay my return by a day, and I was to return on Monday, September 18th.  I took my work computer with me on the trip on a hunch I might need it before I got back to Dominica.  I had no idea how right I was.

As I worked at my business meeting, I kept following the progress of Maria, joking that it might just prevent me from returning on Monday, but hoping that it would turn like so many storms before it.  This was not to be. By late Saturday even though it was only tropical storm strength, it was apparent that on Sunday the regional airlines were going to evacuate their small aircraft to havens like Aruba and Curacao to the south and Central America to the west.  Since there weren’t going to be any flights, my travel agent arranged for me to go back to my family in Georgia on that Monday to wait out the storm.  We expected I probably wouldn’t get back to Dominica until air service was restored to Puerto Rico, probably four to six days after I’d originally been scheduled to return to Dominica.

September 18th, 2017… Imagine being inside a tornado.

Imagine looking up to see your roof flying away and then the wind and rain coming in on top of your inadequate shelter as you brace your feet against the closet door, hoping it will hold.  Imagine hanging on for hours and hours of storm, enduring howling winds and painful rain and your stuff blowing away around you, hoping you wouldn’t die. If you have trouble imagining it, so do I, because I wasn’t there.  My colleagues who were there said that I was the luckiest person at the school, to be thousands of miles away that fateful day. From my computer screen at home that night I watched the storm give Dominica a direct hit with 160 mile per hour sustained winds, and turning only as the eye was literally over the island such that the entire west coast of the island was struck by the eyewall of Category Five Hurricane Maria.  As I flew home over the United States that day, eighty to ninety percent of the buildings in the country were about to be damaged or destroyed, the hospital, power generators and water reservoirs damaged or destroyed, and the roads and bridges so shakily repaired after Erika destroyed again (6).  The morning after the storm, people went out and saw that not one tree had escaped unscathed on the entire island, and in many places the trees had lost their bark or been snapped in two (7).  Virtually every telephone pole was either in need of repair or down entirely. The airport was knocked out again from both rain and the river beside it washing through the terminal and over the runway. Unlike with Erika, the seaport and its dock and warehouse capacity on the west coast was heavily damaged as well.  And of course, dozens of people were dead and dozens more are still missing to this day. The island was brought to its knees.

A few days after the storm, the prime minister declared in a speech to the United Nations General Assembly that “Eden is broken” (8).

Photo: GOES-16 visible image of Maria just before sunset, at 5:17 pm EDT Monday, September 18, 2017. Image credit: NOAA/RAMMB. (9)

At our campus, that brand new hurricane-proof building delivered.  All of our people were safe, though many of our older buildings were heavily damaged.  The French islands north and south of us weren’t so badly damaged and they were able to get helicopters up to survey the scene of total devastation that Dominica had become.  Our campus became a site for them and other rescuers to base, as it was more functional than any other location on the north side of the island.  With help from many others including the U.S. military, over a thousand students, faculty, staff, and family members were evacuated off the island through seas crowded with entire forests of dead trees and other debris.  Our CEO was there to greet many Ross refugees in Miami as they returned to the US to an uncertain future.  And as before, I watched it all from a distance, not personally devastated as they were but a refugee just the same.  I found out from a colleague who had been my neighbor that my concrete cottage had held up better than most. Like three of the other cottages in the complex it still had both a roof and windows following the storm, but no one could say if anything inside had survived the flooding, or whether the post-storm looters who sadly went through many other places had broken in after they were evacuated.  As soon as I could, I checked in with my school to let them know where I was and that I was safe. I was told to sit tight and wait for instructions, just like everybody else.  So that’s what I did, for several weeks.

Stay tuned for next week’s exciting conclusion…

 

Bruce E. Wright graduated with a PhD in Physiology from LSU Health Sciences Center in 1993.  He had postdoctoral fellowships/research faculty positions at the University of Florida and East Carolina University.  He served several years as faculty at a liberal arts college in Georgia.  He worked at three Caribbean medical schools from 2005-2008 before joining the faculty at Ross University School of Medicine in 2008.  He worked for two years at a US-based osteopathic medical school in 2013 and 2014 before returning to Ross University in late 2014.  Dr. Wright is currently Treasurer/Award & Event Coordinator for the American Physiological Society’s Teaching Section.  He has served as a reviewer for Advances in Physiology Education.  He is National Faculty for the National Board of Osteopathic Medical Educators (NBOME), for whom he has written and reviewed items for different exams.  He regularly attends Experimental Biology and was an attendee and presenter for the first Institute for Teaching and Learning meeting in Bar Harbor, Maine in 2014.  He is currently interested in educational research involving teaching methodologies.

References/links/other:

        1. http://www.dominica.gov.dm/about-dominica/country-profile
        2. https://medical.rossu.edu/about.html
        3. http://www.dominica.gov.dm/tropical-storm-erika
        4. https://weather.com/storms/hurricane/news/tropical-storm-harvey-forecast-texas-louisiana-arkansas
        5. https://weather.com/storms/hurricane/news/hurricane-tropical-storm-irma-recap-2017
        6. https://en.wikipedia.org/wiki/Hurricane_Maria
        7. https://www.youtube.com/watch?v=l-5fHwER-Zc
        8. https://www.caricom.org/media-center/communications/press-releases/dominica-prime-minister-roosevelt-skerrit-addresses-the-un-general-assembly
        9. https://www.wunderground.com/cat6/category-5-hurricane-maria-hits-dominica
        10. https://veterinary.rossu.edu/about.html 
Beyond Content Knowledge: The Importance of Self-Regulation and Self-Efficacy

You can lead students to knowledge, but you can’t make them understand it …

Undergraduate physiology education has been steadily morphing from a traditionally instructor-centered, didactic lecture format to a more inclusive array of practices designed to improve student engagement and therefore motivation to learn.  Many excellent resources are available regarding the theory and practice of active learning (4) as well as guidelines specific to teaching physiology (2).  Common questions instructors ask when redesigning courses to be student-centered, active learning environments are often along the lines of:

  1. What specific content areas should I teach, and to what depth?
  2. What active learning strategies are most effective and should be included in course design? Common methodologies may be in-class or online discussion, completion of case studies, team-based learning including group projects, plus many others.
  3. How do I align assessments with course content and course activities in order to gauge content mastery?
  4. How do I promote student “buy-in” if I do something other than lecture?
  5. How do I stay sane pulling all of this together? It seems overwhelming!

These last two questions in particular are important to consider because they represent a potential barrier to instructional reform for how we teach physiology– the balance between student investment and responsibility for their learning versus time and effort investment by the instructor.  All parties involved may exhibit frustration if instructor investment in the educational process outweighs the learner’s investment.  Instructors may be frustrated that their efforts are not matched with positive results, and there may be concerns of repercussions when it comes time for student course evaluations.  Students may perceive that physiology is “too hard” thus reducing their motivation and effort within the course and possibly the discipline itself.

To improve the likelihood of a positive balance between instructor and student investment, perhaps we should add one additional question to the list above: What is the learner’s role in the learning process?   

Students often arrive to a class with the expectation that the instructor, as the content expert,  will tell them “what they need to know” and perhaps “what they need do” to achieve mastery of the factual information included as part of course content.  This dynamic places the responsibility for student learning upon the shoulders of the instructor.  How can we redefine the interactions between instructors and students so that students are engaged, motivated, and able to successfully navigate their own learning?

 

Self-Regulated Learning: A Student-Driven Process

Self-regulated learning is process by which learners are proactive participants in the learning process.  Characteristics associated with self-regulated learning include (4):

  • an awareness of one’s strengths and weaknesses broadly related to efficacious learning strategies (e.g., note-taking)
  • the ability to set specific learning goals and determine the most appropriate learning strategies to accomplish goals
  • self-monitoring of progress toward achieving goals
  • fostering an environment favorable to achieving goals
  • efficient use of time
  • self-reflect of achievement and an awareness of causation (strategies à learning)

The last characteristic above, in particular, is vitally important for development of self-regulation: self-reflection results in an appreciation of cause/effect with regard to learning and mastery of content, which is then transferrable to achievement of novel future goals.  Applied to undergraduate physiology education, students learn how to learn physiology.

At one point recently I was curious about student perceptions of course design and what strategies students utilized when they had content-related questions.  The following question was asked as part of an anonymous extra credit activity:

The results of this informal survey suggest that, at least in this cohort , undergraduate students generally did have a strategy in place when they had content-related questions—utilization of online resources, the textbook, or the instructor via e-mail to review how others have answered the question.  The good news (if we can call it that) is that only one student reported giving up and did not attempt to find answers to questions.  However, it is interesting to see that only 14% of respondents reported using critical thinking and reasoning to independently determine an explanation for their original question.  Extrapolating to a professional setting, would I want my health care provider to be proficient at looking up information that correlates with signs and symptoms of disease, or would I prefer my health care provider capable of synthesizing a diagnosis?  Thus, self-regulation and having an action plan to determine the answer for a particular question (or at least where to find an answer) may only be part of the learning process.

 

Self-Efficacy: A Belief in One’s Ability to Achieve a Defined Goal

While self-regulation refers to a collection of self-selected strategies an individual may use to enhance learning, self-efficacy is the confidence that the individual possesses the ability to successfully apply them.

Artino (1) has posed the following practices associated with building self-efficacy in medical education.

  • Help students with the goal-setting process, which could be related to learning or the development of skills and competencies; facilitate the generation of realistic and achievable goals
  • Provide constructive feedback, identifying specific areas for which students are demonstrating high performance and areas for improvement
  • Provide mechanisms to compare self-efficacy to actual performance; this could take the form of instructor feedback, metacognitive strategies, self-assessments, and self-reflections
  • Use peer modeling and vicarious learning; best practices would be to use peers at a similar level of competence who are able to demonstrate successful achievement of a learning goal

I am interested in the relationships between self-regulated learning, self-efficacy, how students learn physiology, and tangentially student perceptions of my role as the instructor.   Thus, here is another example of a self-reflection activity that was offered in an online class-wide discussion forum as extra credit (Hint: extra credit seems to be a sure-fire way to promote student engagement in self-reflection).  Once students responded to the prompt shown below, they were able to review other student’s responses.  Following the due date, I diplomatically consolidated all responses into a “peer suggestions for how to learn physiology” handout.

Three outcomes were in mind when creating this activity:

  1. To encourage students to think about the control they have over their own learning and recognize specific practices they can utilize to empower learning; also peer modeling of learning strategies
  2. To set reasonable expectations for what I can do as the instructor to foster learning, and what I cannot do (I would make it easy to understand all physiological processes, if only I could…)
  3. To plant the seed that course activities build content knowledge applicable to a future career goal, which hopefully translates into increased motivation for active participation in course activities

 

Beyond Content Knowledge: Integration of Self-Regulation and Self-Efficacy into Course Design

Incorporation of activities to build self-regulation and self-efficacy can be included along with content knowledge in the active learning classroom environment.  Moving away from didactic lecture during class time to a more flexible and dynamic active learning environment provides opportunities to discuss and model different learning strategies.  If incorporated successfully, students may experience increased self-efficacy and self-confidence, setting the precedent for continued gains in academic achievement and subsequently the potential for professional success.

It is also important to consider that what we do in the classroom, in a single course, is just one piece of the undergraduate educational experience.  Currently there is a call for undergraduate physiology programmatic review and development of cohesive curricula to promote knowledge of physiology as well as professional/transferrable skills and competencies directed toward a future career (3).

If the overarching goal of an undergraduate education is development of knowledge, skills, and abilities transferrable to a future career, as well as life-long learning, it is vitally important that discussion of self-regulated learning and self-efficacy are included within the curriculum.   Although this seems a daunting task, it is possible to purposefully design course structure, and indeed programmatic structure, with appropriate activities designed to enhance learning and self-efficacy.  One key suggestion is to make the inclusion of knowledge, skills, and competencies transparent to boost awareness of their importance, throughout the educational experience.  Here is one example of what this could look like:

 

Students frequently focus upon content knowledge, and subsequently their grade as the primary outcome measure, rather than seeing the “big picture” for how the sum total of course activities most likely directly relate to their professional goals.

A second key component to building well-prepared and high achieving undergraduates is to involve your colleagues in this process.  It takes a village, as the saying goes. Talk to your colleagues, decide which course/s will emphasize specific attributes, and also be a united front.  If students hear the same message from multiple faculty, they are more likely to recognize its value.

Finally, course or curricular reform is time-consuming process.  Don’t expect the process to be complete within one semester.  There are many excellent resources related to backward course design, core concepts of physiology as conceptual frameworks for student learning, student-centered activities, etc.  Be purposeful in selecting 1-2 areas upon which to focus at a time.  Try it out for a semester, see how it goes, and refine the process for the next time around.

 

Jennifer Rogers, PhD, ACSM EP-C, EIM-2 received her PhD and post-doctoral training at The University of Iowa (Exercise Science).  She has taught at numerous institutions ranging across the community college, 4-year college, and university- level  higher education spectrum.  Jennifer’s courses have ranged from  small, medium, and large (300+ students) lecture courses, also online, blended, and one-course-at-a-time course delivery formats.  She routinely incorporates web-based learning activities, lecture recordings, student response activities, and other in-class interactive activities into class structure.  Jennifer’s primary teaching interests center around student readiness for learning, qualitative and quantitative evaluation of teaching  strategies, and assessing student perceptions of the learning process.

Dr. Rogers is a Lecturer in the Health & Human Physiology Department at The University of Iowa.  She is the course supervisor for the Human Physiology lecture and lab courses.  Jennifer also teaches Human Anatomy, Applied Exercise Physiology, and other health science-focused courses such as Understanding Human Disease and Nutrition & Health.

  1. Artino AR. Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ 1:76–85, 2012.
  2. Michael J, Cliff W, McFarland J, Modell H, Wright A. The Core Concepts of Physiology: A New Paradigm for Teaching Physiology. Published on behalf of The American Physiological Society by Springer, 2017.
  3. Wehrwein EA. Setting national guidelines for physiology undergraduate degree programs. Adv Physiol Educ 42: 1-4, 2018.
  4. Zimmerman BJ. Becoming a self-regulated learner: an overview. Theory Into Practice, 41(2): 64-70, 2002.
Stress and adaptation to curricular changes

 

 

 

…there was a teacher interested in enhancing the learning process of his students. He wanted to see them develop skills beyond routine memorization. With the support of colleagues and the education team at his university, he succeeded and chose a semi-flipped classroom approach that allowed him to introduce novel curricular changes that did not generate much resistance on the part of the students.

The change was made. The students apparently benefited from the course. They worked in groups and learned cooperatively and collaboratively. Students evaluated peers and learned to improve their own work in the process. They not only learned the topics of the class, but also improved their communication skills.

At some point the institution asked the teacher to teach another course. He happily did so, and based on his experience introduced some of the changes of his semi-flipped classroom into the new course. The students in this course were slightly younger and had not been exposed to education in biomedical sciences. To the teacher’s surprise, the students showed a lot of resistance to change. The sessions moved slowly, the test scores were not all that good, and students did not reach the expected outcomes. It was clear that the teacher and the students were going through a period of considerable stress, while adapting to the new model. Students and teachers worked hard but the results did not improve at the expected rate.

Some time ago this was my experience and as I wandered looking for solutions, I started to question the benefits of active learning and the role of stress in educational practice.

Advantages and challenges of active learning

Evidence says that active learning significantly improves student outcomes (higher grades and lower failure rates) and may also promote critical thinking and high level cognitive skills (1, 2). These are essential components of a curriculum that attempts to promote professionalism. However, it may be quite problematic to introduce active learning in settings in which professors and students are used to traditional/passive learning (2).

Some of the biggest challenges for teachers are the following:

  • To learn about backward design of educational activities
  • To think carefully about the expected accomplishments of students
  • To find an efficient way to evaluate student learning
  • To spend the time finding the best strategies for teaching, guiding, and evaluating students.
  • To recognize their limitations. For example, it is possible that despite their expertise, some teachers cannot answer the students’ questions. This is not necessarily bad; in fact, these circumstances should motivate teachers to seek alternatives to clarify the doubts of students. At this point, teachers become role models of professionals who seek to learn continuously.
  • To learn about innovations and disruptive technologies that can improve the teacher role.

Some of the challenges for students include:

  • Understanding their leading role in the learning process
  • Working hard but efficiently to acquire complex skills
  • Reflecting on the effectiveness of their learning methods (metacognition). Usually reading is not enough to learn, and students should look for ways to actively process the information.
  • Trusting (critically) on the methods made available by the teachers to guide their learning. For example, some tasks may seem simple or too complex, but teachers have the experience to choose the right methodology. A work from our team showed that strategies that seem very simple for the student (clay modeling) have a favorable impact on learning outcomes (3).
  • Seeking timely advice and support from teachers, tutors and mentors.

Working to overcome these challenges may generate a high level of stress on students and teachers. Without emphasizing that stress is a desirable trait, I do find that some disturbance in the traditional learning process and risk taking motivate teachers and students to improve their methods.

Intermediate disturbance hypothesis and stress in education

In the twentieth century, the work of Joseph H. Connell became famous for describing factors associated with the diversity of species in an ecosystem (4). Some of his observations were presented in Charles Duhigg’s book “Smarter Faster Better” which discusses circumstances related to effective teamwork (5). Duhigg reports that Connell, a biologist, found that in corals and forests there might be patches where species diversity increases markedly. Curiously, these patches appear after a disturbance in the ecosystem. For example, trees falling in a forest can facilitate the access of light to surface plants and allow the growth of species that otherwise could not survive (5). Connell’s work suggests that species diversity increases under circumstances that cause intermediate stress in the ecosystem. In situations of low stress, one species can become dominant and eradicate other species, whereas in situations of high stress, even the strongest species may not survive. But if, an intermediate stress where to appear, not very strong and not very weak, the diversity of species in an ecosystem could flourish.

I propose that the hypothesis of the intermediate disturbance can also be applied in education. In traditional learning, an individual (ecosystem) learns to react to the challenges presented and develops a method for passing a course. In situations of low stress, memorization (evaluated at the lower levels of Miller´s pyramid) may be enough to pass a course. In high stress level situations, students may drop out or feel inadequate. However, courses that involve active learning may include moderate challenges (intermediate disturbance). These well-managed challenges can motivate the student to develop more complex skills (diversity of species) that lead to effective learning and a broader professional development.

 

 

 

 

 

 

 

 

 

Figure 1. Intermediate disturbance hypothesis in education.

 

In the book “Problem-based learning, how to gain the most from PBL”, Donald Woods describes the challenges and stresses associated with the incorporation of active learning (PBL) in a curriculum (6). He describes the stages of grief that a student (and I add, a teacher) must go through while adapting to the new system. This adaptation can take months and generally is characterized by the following phases:

  • Shock
  • Denial
  • Strong emotion (including depression, panic and anger)
  • Resistance to change
  • Acceptance and resignation to change
  • Struggle to advance in the process
  • Perception of improvement in the expected performance
  • Incorporation of new habits and skills to professional practice

 

 

 

 

 

 

 

 

 

Figure 2. Performance adjustment after curricular changes. Adapted and modified from (6).

 

Properly managing stress and finding strategies to advance in the process are rewarded by achieving better performance once the students become familiar with the new method of active learning. However, to better adapt to curricular or pedagogical changes, it is important for all the education actors to recognize the importance of deliberate work and to have clear goals. In addition, students and teachers should have access to institutional strategies to promote effective time, and anger and frustration management.

Stress is not ideal, but some stress may motivate students and teachers to reevaluate their methods and ultimately work together for a classroom focused on professional excellence. The critical question is how big is the intermediate disturbance needed to improve learning outcomes. As is commonly concluded in papers, more research is needed to answer this question, and we can learn a lot from the theories and methods from our colleagues in Biology.

References

  1. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A. 2014;111(23):8410-5.
  2. Michael J. Where’s the evidence that active learning works? Adv Physiol Educ. 2006;30(4):159-67.
  3. Akle V, Pena-Silva RA, Valencia DM, Rincon-Perez CW. Validation of clay modeling as a learning tool for the periventricular structures of the human brain. Anat Sci Educ. 2017.
  4. Connell JH. Diversity in Tropical Rain Forests and Coral Reefs. Science. 1978;199(4335):1302-10.
  5. Duhigg C. Smarter Faster Better: Random House; 2016.
  6. Woods DR. Problem Based Learning: How to gain the most from PBL. 2nd. ed1997.
Ricardo A. Peña-Silva M.D., PhD is an associate professor at the Universidad de los Andes, School of Medicine in Bogota, Colombia, where he is the coordinator of the physiology and pharmacology courses for second-year medical students. He received his doctorate in Pharmacology from The University of Iowa in Iowa City. His research interests are in aging, hypertension, cerebrovascular disease and medical education. He works in incorporation and evaluation of educational technology in biomedical education.

He enjoys spending time with his kids. Outside the office he likes running and riding his bicycle in the Colombian mountains.

Five lesson design tips to help your learners find their Happy Place (…with some help from Dr Seuss)

We’ve all been there, that unhappy place at the pointy end of some badly designed learning material. You know the place – it’s grim and grey and jammed full of text-laden power point slides, complicated jargon, and at least one terrifying pie graph with microscopic labeling. It’s a place that’s confusing, generic, and entirely unengaging for you as a learner. In the words of Dr. Seuss, “You will come to a place where the streets are not marked. Some windows are lighted. But mostly they’re darked.”[1]

And dark these places are. The challenge can be even greater when you’re creating online lessons for students to use away from the classroom. But that’s where thoughtful lesson design helps: it switches on the floodlights, clears the way, and points your students in the right direction by putting them at the center of the learning experience, whether a teacher is in the room with them or not.

So, here are five simple design tips for creating effective and engaging online lessons, so you can help your learners find their happy place and stay on track:

 

Tip 1: Keep it simple!

  • Define your learning outcomes and post them in the lesson.
  • If content doesn’t support your instructional goals, delete it!
  • Make notes of relevant, contextual examples that could bring “life” to the learning outcomes, and help students understand why they are learning it.
  • Some hacks specifically for Life Science teaching:

 

Tip 2: Break up the text

  • Use your learning outcomes to help guide you in dividing up / chunking your text.
  • Keep sentences and paragraphs short and simple.
  • Highlight the focal points using headings, text formatting, color, and contrast.
  • Intentionally leave blank space on your lesson pages – it can be a powerful design tool to give important concepts some buffer space to call attention to their importance.
  • Make use of lists, bullet points, and tables to present information:

 

Tip 3: Make it visual

Did you know the old saying, “A picture is worth a thousand words,” is backed by neuroscience? Research suggests that we remember more of what we see than what we read.[2]

Try these:

  • Use icons as virtual “signposts” for extra information. You can use these in multiple lessons to add cohesiveness.
  • Turn information into graphs or infographics for your lessons – you could even turn this into an assessment for students. This works especially well for conveying relationships or showing steps in a process:

Here’s another example of a complementary visual element:

 

These are some of our favorite free resources to help you create or add public domain or Creative Commons media to your lessons:

Note: While free, most of the sources above require proper attribution. Don’t forget to give the creator a virtual high-five by adding a citation to their media!

 

Tip 4: Ask questions

Adding practice and feedback to lessons is the most effective way to enhance the retention and recall of new material [3,4,5]. It also enables students to check their understanding and self-monitor for misconceptions early on in the learning process.

Test it out:

  • Distribute formative questions with feedback throughout lessons, not just at the end. (By making questions formative, the emphasis is placed on learning rather than earning or losing points.)
  • Mix up question types: categorizing, matching, ordering, and labeling exercises, MCQs, completing tables, free recall, etc. Variety in quizzing strengthens the ability to recall information down the road.
  • Are there still big blocks of text in your lessons? Try turning text into interactive questions! Students can order steps in a process, match terms and definitions, correct false statements into true statements, categorize by function, characteristic, etc.
  • Ask questions and create activities that check knowledge about the most important aspects of the instruction. Use your learning objectives to guide you!

 

Tip 5: Connect & reflect

Ask students to draw out new questions, connections, and conclusions through reflective activities. Actions like summarizing information into words or diagrams help students organize new information into preexisting schema, aiding the conversion of long-term memory [3,4].

 

Some reflective ideas:

  • Teach a new concept to friends or family members.
  • Brainstorm analogies that link new topics to well known ones.
  • Create a mind map or other visual or auditory representation that highlights the main points and connections between concepts.
  • Ask students how they would respond in a series of scenario-based questions.
  • Design a research project or critique a research paper.
  • Brainstorm what questions they still have about the subject, to encourage curiosity and further self-directed learning.

________

Ultimately, even simple tweaks to how you display information will have a big impact on students’ attitude toward and engagement with course materials. To help, download this cool infographic of our lesson design tips to keep handy when designing your lessons!
These design elements are a way to shift from instructor-led lessons to ones where the student is the center of the design and learning experience. If you can spend a small amount of time and effort on lesson design it can greatly enhance student motivation and increase time on task – turning them into the brainy, footsy, mountain-moving achievers they are destined to be.

 

The only question now is…will you succeed?

Yes! You will, indeed!

(98 and ¾ percent guaranteed) [1]

 

References:

[1] Seuss, Dr. (1990). Oh, the places you’ll go! New York: Random House.

[2] Medina, J. (2014). Brain rules: 12 principles for surviving and thriving at work, home and school. Seattle: Pear press.

[3] Brown, P. C., Roediger, H. L., & McDaniel, M. A. (2014). Make it stick: the science of successful learning. Cambridge, MA: The Belknap Press of Harvard University Press.

[4] Malamud, C. (2016, Oct 6). Strategies For Effective Online Instruction: A Conversation with Michelle D Miller. The eLearning Coach Podcast. [Audio podcast] Retrieved from http://theelearningcoach.com/podcasts/36/

[5] Larsen, D. P, Butler, A.C., and Roediger, H. L. (2008). Test-enhanced learning in medical education. Medical Education. 42: 959–966. doi:10.1111/j.1365-2923.2008.03124.x

 

Ellen Crimmins (MS) is an instructional designer and ocean enthusiast. She loves studying how people learn and working with educators to bring their online lessons to life. Away from the computer screen, you can find her exploring nature trails and 50s themed diners with her better thirds (husband and dog).
Sina Walker (MSciComm) is a writer and former natural history filmmaker. She has three little boys so doesn’t have time for many hobbies, but enjoys taking mom-dancing to new levels of awesome.
Marissa Scandlyn (PhD) is a product manager at ADInstruments by day, and a netballer by night. She’s researched new drug treatments for breast cancer and children’s leukemia with her pharmacology background, and was previously the coordinator of ADI’s team of Instructional Designers. Marissa enjoys reading, movie watching, and being mum to the cutest dog in the world, Charlie.